In 2007, supported by an extraordinary team of family, friends, and medical staff, I stomped the snot out of a nasty cancer that was on its way to killing me. I've since learned that the way I did it has a lot in common with the advice of the "e-patients" movement, so I've changed my blogger name from Patient Dave to e-Patient Dave.

Thursday, October 9, 2008

I'm reading Best Care Anywhere. This book is hot, and I want to share it with you, but I don't want to wait until it's finished. Also, sometimes when I think too much, I talk too much. So I'm going to try something new.

As I read, I'm highlighting like crazy. As I finish each chapter, I'm just going to post the highlighted parts.

Why is it hot? Because a lot of people I know are wandering around (figuratively) wondering what we can do to make healthcare better, and the US Veterans' Administration has been doing (for years) what I think everyone ought to be doing: taking a long-range view of the total patient, not a short-range view of "what costs will we approve and incur this quarter or this year?" When you look at it that way, a lot of other answers fall out pretty easily.

For instance years ago the VA pioneered e-prescribing, vastly reducing medication errors caused by handwriting; most hospitals don't have that yet. The VA invests in early detection, because unlike your average insurance company, they're responsible for that patient for the rest of his/her life. And so on.

This surprises a lot of people because we keep hearing scandals about VA hospital abuse. This will be covered in the notes. One thing to bear in mind: there's a difference between quality of care, and access to that care. Another: sometimes there have been political agendas involved. We'll get to that; for now, just listen for what works.

The author's perspective

The book grew out of an assignment by Fortune to document that government-administered healthcare would be a disaster. The author, a pro-market anti-government thinker, fully agreed. But there was a problem: a few years earlier his wife had been through a terminal cancer, and they'd witnessed all too clearly the inefficiencies and gross errors that are too common in US healthcare today ... and he didn't find that in the VA.

To the contrary, he found a system where they actively prioritize eliminating causes of errors, and they do it successfully. Although he expected to find that "socialized" (government-run) healthcare would be bloated and inefficient,

...as I started asking experts for suggestions about who was delivering the highest-quality, most cost-effective, innovative, and scientifically driven health care in America, I kept hearing an answer I could not believe. It contradicted all that I knew about health care and medical economics, indeed, about markets and governments in general. Yet these experts backed up their assertion by pointing me to study after study ... in prestigious, peer-reviewed journals.

And here's the punch line:

I knew the editors of Fortune would never feature it on their cover. And I was right. We agreed on a kill fee with no hard feelings. Business is business.

Ain't that grand? BUT: he pursued the subject, and wrote this book.

A solution to America's health care crisis does exist, I realized. Better than that, you don't have to rely on mere theoretical speculations or econometric simulations to see how it might work, nor do you have to wait around for a revolution in technology. You don't even have to travel to some far-off foreign country like Sweden, or even Canada, to see it in operation. It's already up and running, right here in America.

Stay tuned. (Or just buy the book - this one's worth the $10.17 at Amazon, and you can do your own highlighting.)